I thought I would share some more from the wonderful book I have been reading on addiction, “The Biology of Desire:Why Addiction Is Not A Disease.” As my long-time readers will recall, it is my opinion that carbohydrates are an addictive substance. Eating can become an addictive behavior. The over-eater who eats compulsively is not different than the one that has gotten past it already. The addict and the post-recovery addict are wired the same, and realizing that there is nothing different between them and you changes the entire way that you deal with those who are struggling in your family or neighborhood. This book applies to you, to your friends and family, even if you don’t yet realize that it does.

The road to true ‘addiction’ has common signs on the way. It all starts innocently, as trying something new and exciting. In the book, there are several case studies and one is of a very successful businessman whose descent into alcoholism was gradual until, toward the end, it descended rapidly into something unmanageable. He was seemingly choosing to destroy his life’s work, his marriage, and the livelihoods of all of his employees–for liquor…

For Johnny, this was the monster sleeping under the bed during his long flirtation with alcohol. He’d been able to control his drinking before the final six months. He liked his booze, he desired it, he often drank far more than he should have. But it was not an automatic response. He did not drink mindlessly. He drank to experience more of what he wanted. And once the drinking became automatic, there was still pleasure for a while— an hour or so.

The problem is directly tied to the bolded word. I bolded that word because it means many things to many people. When his problem was ‘manageable’ he was not drinking mindlessly. It was on purpose. Once it became automatic, mindless, it became COMPULSIVE behavior. The shift from impulsive to compulsive is accomplished inside the brain, it is when behavior shifts to the dorsal striatum. This part of the brain needs no trigger to cause the brain to seek a result. This part of the brain just goes straight for the result for no apparent reason, even if the behavior is unreasonable.

But pleasure seeking did not motivate the fourth and fifth and sixth and seventh drinks. In fact, we might imagine that desire was no longer part of the equation. Rather, he drank because his dorsal striatum was converting dopamine into a behavioural command. He drank because it was too hard to stop.

“He drank because it was too hard to stop.” If you have never been here, you cannot imagine the horror of doing something destructive and not really knowing why you are doing it. It was too hard to stop. This is why lots of addicts have to descend all the way to ‘the bottom’ before they can ever begin to pull out of the dive they are in.

Then what was the stimulus that compelled him? It may have simply been the empty glass in his hand. Or, on first waking, the awareness of being sober or nauseated. Or, as Robbins and colleagues also suggest, it may have been a mental image of the negative consequences of not drinking: the dawning awareness of what he did not want to face, the rational considerations he needed to avoid— the shame of it. Shame had been a frequent visitor through much of Johnny’s life. And now it was grossly augmented by his alcoholism. Shame is one of the most painful emotions. The urge to ease it can be overwhelming, and here the self-medication model of addiction rings true. Yet we can still see desire at work— the desire to avoid pain, the desire for relief. And what about anxiety? Every morning of his self-imprisonment, Johnny was assaulted by the immediate anticipation of nausea— and of anxiety itself. Anxiety about anxiety. By the age of sixty-three, Johnny was painfully anxious about being awake from the moment he first woke up.

I can hear you arguing, “well, of course there is shame in drinking yourself blind every day.” This man is self-medicating, this must be the reason… Once behavior is to this point, where there is no longer any thinking involved, it is automatic, compulsive, then all of the thinking is required to stop–not start the behavior. This applies to all compulsive behavior; overworking, gambling, dangerous sports, sex, not just those that are chemical. There is shame where you are acting outside of the best interest of your self and your family. You feel guilty, you feel shame, but you can’t help it. It is automatic. Why can’t the person in this destructive autopilot mode pull out?

But self-control wasn’t working for Johnny. Why not? Because when habits get ingrained, some of the two-way traffic between the striatum and the prefrontal cortex starts to thin out. Especially on roads leading to a region called the dorsolateral prefrontal cortex, which is critical for reasoning, remembering, planning, and self-control. We can think of the dorsolateral PFC as the bridge of the ship, because it steers thought and behaviour deliberately, consciously, and often skilfully, overcoming challenges and setbacks. This region becomes hyperactivated in the early stages of addiction, perhaps when people try to control or maintain the enchantment of this new experience.

But then something starts to give way. We’ve been taught to think “use it or lose it” when imagining brain function. But in the case of the dorsolateral PFC and its role in addiction, you both use it and lose it. Over time, the dorsolateral PFC and other prefrontal control centres start to disengage from the striatum when the addictive substance is at hand. I just feel like doing it, so why not? Disengagement leads to disuse, and disuse leads to dissolution. In long-term addiction, some cognitive control regions may actually lose a fair number of synapses— they may become pruned, and show up on brain scans with a “loss of grey matter volume” (grey matter being the stuff of neurons and their synapses). Whether the addiction is to alcohol, meth, coke, tobacco, or heroin, grey matter volume in some prefrontal areas has been thought to decrease by as much as 20 percent. And the degree of loss appears to correspond with the length and severity of the addiction. According to this view, the communication between prefrontal control and striatal compulsion isn’t only constricted; it’s become fragmented or inaccessible. That’s not hard to imagine in Johnny’s case.

In long-time addicts (think food) the ability to ‘just say no’ is actually removed from their brains. This makes sense if you think that it would save a lot of energy for your brain to not keep debating an issue that has been decided so often in the direction of ‘just do it.’ It’s really efficient for lots of our behaviors to be automatic.

The good news is that most compulsive behavior can be corrected and the brain that changed one way can, over time, change back. The motivation has got to be very strong, the brain has to see it practically as life or death. Sometimes the change happens in prison. Sometimes in rehab the change can happen, as long as the rehab doesn’t reinforce the negative self-image of the victim. It can happen with you working on yourself, but that is so hard, because rewiring the brain is not something you can consciously do.

For overeaters, the good news is that all you have to do is quit eating carbohydrates. You can keep eating, but it just can’t be sweets, cakes, crackers, Cokes. The thing that must happen to get out of any compulsive loop is to replace it with another behavior. In the case of eating you don’t have to replace eating with another behavior. All you have to do is quit eating carbohydrates. This is tough when a vendor brings pizza to work. This is tough when friends buy you a decadent dessert at the restaurant for your birthday. The nice thing though, is that the cake and the pizza are not products of your compulsion. You will or will not eat them in that moment, but you will not eat them MINDLESSLY. You will not be reinforcing the habitual, compulsive eating that is getting you sick.

Mindfulness is the answer to addiction, all of them. The ability to keep thinking in the face of compulsion is the most critical factor. When you find yourself halfway down the road to your drug connection, finding the mental energy to just turn left instead of turning right is where the magic happens. When you realize you are on a well worn path and finding the mental image revolting is how you get off that path. “Letting Yourself Go” strengthens the mental path to compulsion. Letting the better angel win will strengthen that angel for the next time–and there will be a next time.

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About dcarmack

I am an instrument technician at the electric utility servicing the Kansas City Missouri metropolitan area. I am in the IBEW, Local 412. I was trained to be a nuclear power plant operator in the USN and served on submarines. I am a Democrat, even more so than those serving in Congress or the White House.

2 Responses to One More on Addiction

I learned a lot by reading this post. I write about change – to better myself and I hope to inspired others to do the same. I understand the whole mindless concept turning into compulsive behavior. I would love to know if you have written about actionable ways to change a habit. I know that emotionally charged desire is important and replacing one habit with a better one is too – but what else can help?

I certainly have, let me search some examples up for you. In the meantime, I would say that changing the compulsion circuitry in the brain is VERY difficult. I have found that since I turned 50 it is much easier to gain new compulsive behaviors. I still compulsively eat sweets, if they are available, unless I am diligent about eating plenty of breakfast. In my life I can change a compulsion by starving it of instances where it’s possible to perform the rituals of compulsive behavior.